Provider Demographics
NPI:1932158482
Name:ZACHARY, DEBBIE (CNFP)
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:CNFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-0351
Mailing Address - Country:US
Mailing Address - Phone:601-542-3300
Mailing Address - Fax:601-542-5999
Practice Address - Street 1:1081 SECOND ST
Practice Address - Street 2:
Practice Address - City:OSYKA
Practice Address - State:MS
Practice Address - Zip Code:39657-8076
Practice Address - Country:US
Practice Address - Phone:601-542-3300
Practice Address - Fax:601-542-5999
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR501433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117273Medicaid
MS500000692Medicare PIN
MSS25134Medicare UPIN